They are

the Ottawa Paramedic Service (OPS), the Ontario

the Ottawa Paramedic Service (OPS), the Ontario Ministry of Health and Long-Term Care, the Regional Paramedic Program of Eastern Ontario (RPPEO), and the Ontario Base Hospital Group Medical Advisory Committee (MAC). More specifically, we would like to thank the following individuals for their support and expertise: Deputy Chiefs Pierre Poirier and Peter Kelly (OPS); Michael Martin, Catherine Tourangeau, Ed Ouston, and Janice Woods (OPS); Dr. Richard Dionne, John Trickett, Julie Sinclair, and Kristy Smaggus (RPPEO); and Dr. Rick Verbeek (MAC). Last but not least, we are extremely grateful for the attention and support provided to this study Inhibitors,research,lifescience,medical by our proud paramedics.Road traffic injuries (RTIs) are a major public health problem globally causing more than a million deaths and almost 50 million injuries every year

[1]. Low and middle income countries (LMICs) account for 90% of Disability Adjusted Life Years (DALYs) lost and for 90% of the deaths from road traffic crashes [1-3]. As the majority of trauma Inhibitors,research,lifescience,medical deaths in LMICs occur in the pre-hospital setting [4-6], it is suggested that improvements in pre-hospital trauma Inhibitors,research,lifescience,medical care can contribute to a decrease in crash-related mortality and morbidity [4,7-11]. The pre-hospital trauma care process consists of six key steps: detection, reporting, response, on-scene care, care in transit and transfer to definitive care [12] (The six steps inspired from the Emergency Medical Services-EMS-symbol or so-called ‘Star of Life’ symbol created by the US National Highway Traffic Safety Administration which presents six EMS functions[13]). The essential Inhibitors,research,lifescience,medical elements of a pre-hospital trauma care system include prompt communication and activation of the system, timely response of the system, correct assessment and efficient treatment, and prompt transport

of injured people to a formal health-care facility Inhibitors,research,lifescience,medical when necessary [14]. EMS is responsible for providing pre-hospital trauma care in many countries and can be described as the link between pre-hospital care and care at the hospital. The World Bank [15] has presented an overview of the role of EMS and key issues when providing trauma care for injured people (see Table ​Table11). Table 1 Overview of Emergency Medical Services Many LMICs have insufficient pre-hospital trauma care [1,16,17], few victims receive treatment at the crash scene and even fewer receive safe transport to the hospital by an GDC-0449 datasheet ambulance. Injured people are usually cared for and transported to the Calpain hospital by relatives, untrained laypeople or drivers of commercial vehicles [1,10,16-18]. Iran with one of the highest RTI death rates (annually with over 27,000 deaths and about 0.8 million injured) in the world [19-21] has a situation similar to that described above. Studies in Iran have shown that about 60% of the deaths occurred at the crash scene or on the way to hospital and more than 30% at the hospital [6,20,22].